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Olecranon (Elbow) Fractures

Definition:
An olecranon fracture is a break of the ulna, one of the three bones that make up the elbow joint. It is often called the ‘funny bone’.

Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to rotate the palm up or down. The shape of the bones keeps the elbow joint in its correct alignment, with the upper part of the ulna, the cup-shaped olecranon, holding the end of the humerus and moving around it as the elbow bends. The triceps muscle, that pulls on the olecranon and causes the elbow to bend, has its attachment on the olecranon.

When the elbow is bent, it is easy to feel the olecranon as the bony tip of the elbow, just under the skin. It is not protected by muscles, fat, or other soft tissues, so is vulnerable to breaking if subjected to a strong force, or by falling directly onto it. An olecranon fracture is therefore a fairly common injury.

Causes:
The most common reason for a fracture of this sort is a fall directly onto the tip of the elbow, or a heavy blow. Examples of such situations are motor vehicle accidents and sporting injuries.

It is also possible to fracture the olecranon by falling onto an outstretched arm. In this instance the triceps muscle pulls a piece of bone off the olecranon.

Symptoms:

Pain, often severe, at the moment of injury

Often a complete inability to move the elbow

Tenderness, swelling, and bruising of the elbow

Possible numbness or tingling in the fingers

Diagnosis:
Due to the pain and obvious severity of the injury, most patients are diagnosed in the emergency room. The doctor will ask about the circumstances of the injury, and also about your general health. Your elbow will be examined to assess the injury and to check if there are associated injuries to other structures. Proper blood flow to the hand and fingers will be checked, as will nerve responses. It is likely that your shoulder, upper arm, forearm, hand and fingers will also be examined to rule out other injuries.

X-rays will be taken to view the bones of the elbow and, if other injuries are suspected, possibly taken of the arm and shoulder as well.

Treatment:
First aid will include icing the elbow to begin reducing swelling, administering pain medication, and immobilizing the elbow in a splint. The splint runs under the elbow, forearm, and wrist, and is usually open on the top to allow for varying degrees of swelling.

Treatment then depends on the extent of the fracture. If the bone is broken but still in its correct position, treatment may consist of continued wearing of a splint, cast or hinged fracture brace for several weeks, combined with regular visits to the doctor and X-rays to monitor healing. If, during this time, the bone shifts out of position, surgery might become necessary. If the bone remains stable, after a few weeks you would begin rehabilitative exercises, probably under the supervision of a physical therapist. Prolonged immobilization in a splint causes the elbow to become very stiff so recovering full range of motion can be a lengthy process.

If the fractured olecranon pierced the skin (an ‘open’ fracture), the risk of infection is serious. Surgery would take place immediately to thoroughly clean the wound and fix the bone into a proper healing position.

Surgery is always required if the bone pieces are displaced. Your surgeon would realign the bone pieces and hold them, using fixation devices such as orthopedic screws, plates or pins, in a proper position for healing. It is also possible for the bone pieces to be held by means of sutures (stitches). In some cases the bone is so shattered that the fragments are simply removed and the triceps tendon is attached to the remaining stable bone. Fixation devices can sometimes become irritating due to their position, and may be removed after a year.

After surgery your arm is likely to be placed in a splint. You may also use a sling for a time. Because an olecranon fracture results in considerable elbow stiffness, exercises to regain mobility will likely begin quite soon after surgery. Your doctor or physical therapist will develop a graduated program of exercises for you. To achieve the best result it is extremely important that you follow advice and do the exercises as often as recommended.

Prognosis:
Normally it takes about three months for an olecranon fracture to completely heal. It is not unusual for some residual stiffness to remain in the elbow joint. You may never be able to fully straighten your arm, but the loss of extension is usually only a very small amount, and should not cause any problems.

Very occasionally the fracture does not heal properly, or the bone fragments do not remain aligned. Such a situation would probably require further surgery.

Due to possible damage to the articular surfaces in the elbow, you may have an increased risk of developing osteoarthritis, which may or may not cause painful symptoms.

Exercises:
You should only begin rehabilitation exercises when your doctor has confirmed that the fracture is stable enough for you to do so. Try to do the exercises three times a day. You should not feel any pain when doing these exercises. If you do, stop.Elbow Flex and Extend:
Standing, simply bend and straighten your elbow as far as it will go without force. You should not feel any pain. Repeat 10 times.Rotations:
With your elbow by your side and bent to 90 degrees, carefully turn your hand up and down as far as it will go without force. Repeat 10 times.Ball Squeeze:
Hold a soft ball, about the size of a tennis ball, in your hand. Squeeze the ball as hard as possible with causing yourself pain. Hold for 5 seconds. Repeat 10 times.